Burns of the Integument

• tissue damage inflicted by intense heat, electrical, radiation, or certain chemicals all of which denature cell proteins

• immediate threat is loss of body fluids containing proteins and electrolytes – as fluid seeps from burned surfaces leads to dehydration which then leads to renal failure and circulatory shock

• infection becomes next threat and is the leading cause of death in burn victims

• burned skin is sterile for 24 hours – then bacteria, fungi, and other pathogens can easily invade areas where skin barrier has been destroyed and multiply quickly in the nutrient rich environment of dead tissue

• immune system becomes deficient within 1 – 2 days after severe burn

First Degree• Only epidermis damaged• Heals within 2-3 days

Second-degree burns affect both the (epidermis) and (dermis) causing redness, pain, swelling and blisters.

Affect sweat glands, and hair follicles.

• Third-degree burns affect the epidermis, dermis and hypodermis, causing charring of skin or a translucent white color, with coagulated vessels visible just below the skin surface. These burn areas may be numb.

• Healing from third-degree burns is very slow due the skin tissue and structures being destroyed.

• Third-degree burns usually result in extensive scarring.

Rule of Nines

The most common method for determining total body surface area (TBSA) of the burn for individuals 8 years of age +

Using this method, the body is divided into 11 sections of 9% or multiples of 9%, with the genitalia accounting for the final 1%.

Rule of Nines

Burns are considered critical if• over 25% of body has 2nd degree burns• over 10 % of body has 3rd degree burns• there are 3rd degree burns on face, hands, or

feet• facial burns introduce possibilities of burned

respiratory passages which can swell and cause suffocation

• joint injuries are trouble because scar tissue limits movement

Skin Graft• must remove burned skin,

area is flooded with antibiotics, covered temporarily with synthetic membrane, animal (pig) skin, cadaver skin, or amniotic sac membrane

• Healthy skin is transplanted to burned site from donor site on patient to prevent rejection

• rate of epidermal cell replacement slows – decrease heal time• skin thins – bruising increases and other injuries – decrease

heal time• glands diminish activity causing dry, itchy skin• sweat glands cause trouble with thermoregulation – die in

heat• elastin fibers clump and degenerate - wrinkles• collagen becomes fewer and stiffer - wrinkles

this effect is increased with prolonged exposure to wind and sun

• decrease in # blood vessels and ability to constrict blood vessels – disrupts homeostasis & lowers heal time

• fat layer diminishes- sagging skin &causes intolerance to cold, no heat regulation, and lack of color (pale)

• all of decreasing elasticity of skin and loss of subcutaneous tissue leads to wrinkles

• fewer lymphocytes delay wound healing• melanocytes decrease in # and activity resulting in

less production from UV radiation therefore an increase in cancer rates “liver spots”

• sensitivity to pain and pressure decrease because of decrease in # of receptors – example food on mouth, sore on feet

• # hair follicles dropped by 1/3 at age of 50 and continues to decline resulting in hair thinning also loss of luster (protein in diet) and graying

no way to stop – can slow down process by shielding skin from sun, good nutrition, plenty of fluids, and cleanliness